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General NPI Number Information
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NPI Number | 1568638609
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Entity Type | Organization
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Legal Business Name | STUART L DAVIDSON D D S P C
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 11270 E 13 MILE RD SUITE 3A
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City | WARREN
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State | MI
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Zip | 48093-2599
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Country | US
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Telephone | 586-573-0030
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Fax | 586-573-0072
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Provider Business Mailing Address
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Address Line | 11270 E 13 MILE RD SUITE 3A
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City | WARREN
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State | MI
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Zip | 48093-2599
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Country | US
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Telephone | 586-573-0030
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Fax | 586-573-0072
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Authorized Official
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Title or Position | OWNER
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Name | STUART L DAVIDSON
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Credential | D D S
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Telephone | 586-573-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901007790
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License Number State | MI
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